“The only equality is the pain”: An exploration of the Irish policy sphere's approach to “access” and “entitlement” in health care

This paper critically analyses how overarching policy goals and practices surrounding access and entitlement to health care (HC) have been dominated by a conflicting system of libertarian and equity-based principles. We examine how this mixed-motives system originated and the importance of policy legacies inherited from the Poor Laws era in shaping modern conceptions of access and entitlement to HC. We also considered how these determined the scope of state intervention in this policy domain. Drawing on empirical evidence and interviews with key stakeholders in Irish health policy, we explored the appetite to engage in meaningful HC reforms that address the growing gaps of inequity between higher and lower socio-economic groups in society. Rather than emulating European counterpartsapos; emphasis on universal coverage within an egalitarian paradigm, Irish policy actors have sought to instill a spirit of fairness in HC delivery. Under the guise of equality of opportunity and equity, the policy focus has centred on directing publicly funded HC towards lower-income groups and the most vulnerable in Irish society. However, we argue that the operation of the mixed-motives structure has also created conflict and policy ambiguity surrounding overarching goals which frame the governance and consumption of HC in Ireland. This is evidenced by the dysfunction and complexity of the two-tier system of public-versus-private access to HC services. Ultimately, we argue that the policy aspirations of equality that underpin the HC structures surrounding access and entitlement should be revisited to achieve greater health outcomes and create a more equal society.     

Implementing Dynamics of Immigration Integration in Labor Force Participation Projection in EU28

Population Research and Policy Review - Many developed countries have turned to immigration in order to mitigate the consequences of population aging, particularly the expected decline in the labor...     

Immigration Selection and the Educational Composition of the US Labor Force

Immigration policy is often viewed as an important regulator of the flow of labor and human capital into the labor market. In the US context, this perspective underlies efforts to raise the educational levels of newly admitted US immigrants, which has been proposed through a variety of mechanisms. Yet it remains unclear whether and under what circumstances such changes would significantly raise the educational level of the US labor force. We use a microsimulation model to evaluate the effects of various policy proposals that would seek to admit more highly educated immigrants. Results suggest that adopting a Canadian-style admissions policy that explicitly selects immigrants based on educational attainment would lead to a better educated labor force, especially among immigrants and their descendants. Eliminating all unauthorized immigration or family reunification and diversity admission categories, however, would have minimal impact. Additionally, the effects of all policy scenarios on the educational composition of the entire labor force are likely to be modest and would be conditional on the continuation of intergenerational mobility and high levels of immigration.     

Capability Traps Impeding Homeless Services: A Community-Based System Dynamics Evaluation

Continuums of Care (CoCs) are the primary coordinating bodies for homeless services in the United States. However, the complexities involved in delivering homeless services across interagency networks challenges coordination and system improvement. CoC governance, planning, and service provision have received little attention in academic literature, and thus, Continuums attempt to manage complex systems with little guidance. This evaluation applied community-based system dynamics with homeless consumers and service providers to (1) identify capability traps that impede services delivery and to (2) engage stakeholders in a structured system improvement process. Results revealed organizational structures for governance and planning that inhibit system outcomes. Insights led to policy and practice recommendations for the homeless system.     

Childhood and adult sexual abuse: relationships with alcohol and other psychoactive drug use

Questions concerning sexual abuse before and after the age of 16 years were included in a general population survey of a representative sample of 1052 UK women and 975 UK men. A total of 12.5% of women reported experiencing some form of sexual abuse before the age of 16 years. The corresponding ?gures for men in this category were 11.7%. After the age of 16, the ?gure for women remained at this level. However, the proportion of men reporting these traumatic experiences dropped to 3.2%. Sexual abuse both pre and post age 16 was associated with being single or cohabiting, with higher levels of cigarette‐smoking, alcohol consumption, experience of alcohol‐related problems and use of illicit drugs. The relationship between drinking and other forms of psychoactive drug use and sexual abuse is complex. Some possible explanations for this connection and its therapeutic and practical implications are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

An Approach to Assessing the Impacts of Incident-Free Transportation of Radioactive Materials: I. Air Transportation

Annual radiation doses and risks to passengers and crew are calculated for shipments of radioactive materials in passenger aircraft under accident-free and incident-free conditions (i.e., under normal transportation conditions). The 1982 database developed by Sandia National Laboratories is used, and calculations are made using RADTRAN 4.0. This paper is one of two papers estimating radiological risk associated with incident-free transportation of radioactive materials.     

The role of cohabitation in family formation: The United States in comparative perspective

The prevalence of nonmarital cohabitation is steadily increasing in the United States. In evaluating the contribution of this new living arrangement to family formation, analysts have relied primarily on comparisons between individuals who cohabit and those who do not. We complement this line of inquiry by comparing the United States and 16 industrialized nations. We first identify six conceptually distinct ideal types of cohabitation with respect to family formation. We then propose empirical indicators to distinguish between the different ideal types, and estimate the values of these indicators for each of the 17 nations. Our findings indicate that although a number of countries fit an empirical pattern corresponding to one ideal type, cohabitation in the United States is more difficult to characterize.     

Protection against outliers in empirical bayes estimation

The proven optimality properties of empirical Bayes estimators and their documented successful performance in practice have made them popular. Although many statisticians have used these estimators since the landmark paper of James and Stein (1961), relatively few have proposed techniques for protecting them from the effects of outlying observations or outlying parameters. One notable series of studies in protection against outlying parameters was conducted by Efron and Morris (1971, 1972, 1975). In the fully Bayesian case, a general discussion on robust procedures can be found in Berger (1984, 1985). Here we implement and evaluate a different approach for outlier protection in a random-effects model which is based on appropriate specification of the prior distribution. When unusual parameters are present, we estimate the prior as a step function, as suggested by Laird and Louis (1987). This procedure is evaluated empirically, using a number of simulated data sets to compare the effects of the step-function prior with those of the normal and Laplace priors on the prediction of small-area proportions.     

Parents and Educators: Dialogue and Development Through Partnership

SUMMARY. This paper describes an approach to working with parents which emphasises the parents' own learning process and which might be termed ‘developmental partnership’. By this is meant a relationship in which not only are the parents explicitly acknowledged as the primary educators of their own children but also that, through a process of mutual enquiry into the activities and development of these children, parents, educator and children learn and work together. A number of issues are raised about working in ‘developmental partnership’ with parents, including the role of the unconscious in relationships focused upon learning.